Sleep Disorders

One in Three Individuals are Dissatisfied with Their Sleep Disorders of Sleep One in Three Individuals are Dissatisfied with Their Sleep 58% Adults Snore 36% Complain of Insomnia 15% note persistent Excessive Daytime Sleepiness 3% Unusual Nocturnal Behaviors 28% Workforce on night or rotating shifts

Age and Sleep Disorders

Traditional classification of sleep disorders Dyssomnias: They are associated with difficulty initiating or maintaining the sleep or daytime sleepiness. Parasomnias: Abnormal behavioral or physiological events occurring during sleep but don’t involve the sleep mechanisms.

Primary and Secondary Disorders Traditionally, sleep disorders have been divided into primary and secondary disorders. Primary sleep disorders result from an endogenous disturbance in the sleeping mechanism, often complicated by learned behaviours. Secondary sleep disorders are said to be the result of another disorder –e.g. depression, pregnancy, respiratory problems or gastroesophageal reflux disease

4 x Disorders to be examined: Sleep Disorders Currently, 107 distinct sleep disorders (82 recognized in ICSD2, 25 proposed) 4 x Disorders to be examined: Sleep Apnea Insomnia Narcolepsy Somnambulism (sleep walking)

Dyssomnias

Obstructive Sleep Apnea Repetitive episodes of airway collapse associated with arousals and oxygen desaturation. Patients have hundreds of events per night.

Sleep Apnea – the facts Z Z Z 9-24% Adults Males 3-9% Adult Females Obstructive Sleep Apnea occurs in; 9-24% Adults Males 3-9% Adult Females 3-15% of Children More likely with: Obesity Smoking, Narrow airway, Heart disease Brain disease Z Z Z

Problems with Sleep Apnea Increases the manifestations of other medical and psychiatric disorders: Heart failure, Stroke, Epilepsy, Depression Sudden infant death syndrome (SIDS) is sleep apnea

Treatments: Sleeping pills are not perfect—most bind to GABA receptors throughout the brain. Continued use of sleeping pills: Makes them ineffective Produces marked changes in sleep patterns that persist even when not taking the drug Can lead to drowsiness and memory gaps

OSA Treatment Surgery Dental Device Weight Loss Medication Avoidance of alcohol Sleep on side

Continuous Positive Airway Pressure Fat bloke Machine pumping in air Tube and mask for air supply

INSOMNIA Total sleep deprivation compromises the immune system and leads to death. The disease fatal familial insomnia is inherited— in midlife people stop sleeping and die 7-24 months after onset of the insomnia.

I. Insomnias – the facts Prevalence: 33-36% Accompanied with daytime consequences: 10% Last more than 1 year: 85% (persistent insomnia) Male:female = 1:1.4 Increase with age: above 65 years: 50%

Qu. Why Are Women Not Getting the Sleep They Need? Lifestyle impacts sleep; Working mothers (72%) and single working women (68%) are more likely to experience insomnia 84% pregnant women report insomnia for a few nights each week Other factors; Noise (39%) Giving care to children (20%) Pets (17%)

Other factors causing Insomnia? Primary insomnia – caused by biological factors Inadequate sleep hygiene (10%) Insomnia due to mental disorder (30-40%) Insomnia due to drug or substance

Treatment of Insomnia? Pharmacologic treatment Treating the medical or psychiatric conditions Nonpharmacologic: behavioral treatments: normalizing the circadian rhythm sleep hygiene cognitive behavior therapy sleep restriction therapy

Prescribed Anti-depressants 12% Prescribed Sleep medication 3%

Pharmacologic treatment Benzodiazepines Selective GABA drugs Melatonin receptor sensitising drugs

Problems with insomnia research?

3. Circadian rhythm disorders – a circadian rhythm is a body rhythm which occurs once in a 24 hour period e.g. sleep- wake cycle A normal sleep pattern would be 5 cycles of the of the sleep stages If the sleep-wake cycle is affected then it disrupts our body clock E.g. shift workers But this disorder can occur when there is seemingly no reason Use of bright lights at certain times can help to reset the body clock & thus the sleep-wake cycle is restored

Parasomnias

Narcolepsy SYMPTOMS: Have frequent sleep attacks and excessive daytime sleepiness Do not go through SWS before REM sleep May show cataplexy—a sudden loss of muscle tone, leading to collapse.

Causes of Narcolpsy? Narcoleptic dogs have a mutant gene for a hypocretin receptor. Hypocretin normally prevents the transition from wakefulness directly into REM sleep. Interfering with hypocretin signaling leads to narcolepsy.

Treatments of narcolepsy? Good sleep hygiene Stimulant drugs to help keep you awake during the day. Sodium oxybate is a medicine that can improve cataplexy and help you sleep at night, which can also reduce daytime sleepiness. However, it is not yet funded by the NHS in many areas.

SLEEP PARALYSIS Sleep paralysis is the brief inability to move just before falling asleep, or just after waking up. It can be broken by being touched by someone. It may be caused by the pontine center continuing to signal for muscle relaxation, even when awake.

Qu. When do people get the most incidents of sleep paralysis? Changing sleeping position reduces sleep paralysis

SLEEP WALKING Somnambulism (sleepwalking) occurs during stages 3 and 4 SWS, and may persist into adulthood. 25% children will sleep walk, but most adults lose ability.

(3) REM Sleep Disorder I was a halfback playing football, and after the quarterback received from the centre, he passed it to me and I’m supposed to go around and then cut back in. As I cut back in there is this big 280-pound tackle waiting so I, according to the rules, shoulder barged him….. When I came to I was standing in front of our dresser and I had gotten out of bed and run and knocked lamps, mirrors and everything off the dresser, hit my head against the wall and my knee against the dresser - Schenck et al. (1986)

Critique of Sleep Studies? Labor intensive Require technologists to attend patient all night Technologist must score and summarize the physiology for the recording